姑息治疗进展35年：社会参与的未来是什么？

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY

Journal of pain and symptom management Pub Date : 2025-08-14 DOI:10.1016/j.jpainsymman.2025.08.003

Vilma A. Tripodoro MD, PhD , Marie-Charlotte Bouësseau MD , Stephen R. Connor PhD , Carlos Centeno MD, PhD

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引用次数: 0

摘要

背景：虽然现代姑息治疗始于50多年前，但世卫组织于1990年正式承认它是一个转折点。自那时以来，姑息治疗已从晚期癌症患者的利基服务发展成为纳入全民健康覆盖的全球卫生重点。尽管取得了显著进展，但与健康状况有关的严重痛苦继续增加，特别是在低收入和中等收入国家，要求重新作出道德和战略承诺。目的：批判性地回顾姑息治疗发展的历史轨迹，比较全球框架，突出区域差异，并提出前瞻性的评估和实施策略。方法：这篇特别的文章介绍了姑息治疗发展中的关键政策里程碑、概念转变和全球指标的叙事综合。报告对比了两种世卫组织认可的公共卫生模式：2007年“伞形”战略和2021年“House”框架，分析了它们的互补性和全球相关性。结果：主要转变包括更广泛的姑息治疗定义，增加政府参与，扩大结果衡量标准，更加强调公平和社区参与。尽管取得了这些进展，但在世界各区域之间和区域内部，获取机会仍然严重不平等。最近的举措，如世卫组织指标框架和全球委员会，为取得进展提供了新的工具和道德要求。结论：全球姑息治疗的未来取决于政治意愿、公平的资源分配、强有力的监测和有意义的社区参与。要解决预计到2060年与健康有关的痛苦将增加的问题，并确保不让任何一个人掉队，就必须采取以同情、人权和地方赋权为基础的新的公共卫生办法。对实践的启示：本文支持临床医生、政策制定者和研究人员将他们的实践与新兴的全球标准、道德要求和基于社区的创新相结合，以确保不让任何人掉队。

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35 Years of Palliative Care Progress: What Lies Ahead for Society Engagement?

Context

While modern palliative care began over 50 years ago, its formal recognition by the WHO in 1990 marked a turning point. Since then, palliative care has evolved from a niche service for terminal cancer patients to a global health priority integrated into universal health coverage. Despite notable progress, serious suffering related to health conditions continues to rise, especially in low- and middle-income countries, calling for renewed ethical and strategic commitment.

Objectives

To critically review the historical trajectory of palliative care development, compare global frameworks, highlight regional disparities, and propose forward-looking strategies for evaluation and implementation.

Methods

This special article presents a narrative synthesis of key policy milestones, conceptual transitions, and global indicators in the development of palliative care. It contrasts two WHO-endorsed public health models: the 2007 “Umbrella” strategy and the 2021 “House” framework, analysing their complementarities and global relevance.

Results

Major shifts include broader definitions of palliative care, increased governmental engagement, expanded outcome measures, and stronger emphasis on equity and community involvement. Despite these advances, access remains deeply unequal across and within world regions. Recent initiatives, such as the WHO indicator framework and global commissions, provide renewed tools and ethical imperatives for progress.

Conclusion

The future of global palliative care depends on political will, fair allocation of resources, robust monitoring, and meaningful community participation. A renewed public health approach, grounded in compassion, human rights, and local empowerment, is essential to address the projected increase in health-related suffering by 2060 and to ensure that no one is left behind.

Implications for Practice

This article supports clinicians, policymakers, and researchers in aligning their practices with emerging global standards, ethical mandates, and community-based innovations to ensure that no one is left behind.

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来源期刊

Journal of pain and symptom management 医学-临床神经学

CiteScore

8.90

自引率

6.40%

发文量

821

审稿时长

26 days

期刊介绍： The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.